Skin cancers such as Melanoma, Basal Cell Carcinoma, and Squamous Cell Carcinoma can occur on the face or other parts of the body. Often they are associated with sun damage and fair skin but not in every case. These skin cancers can be directly excised and closed or undergo a process known as Moh’s surgery where precise real-time margins are cleared by the dermatologic surgeon.
Plastic surgeons are often called in to close these defects and there are a number of types of closure and flaps and grafts that can be used for this purpose. Dr. Kim performs many of these skin cancer and Moh’s skin cancer reconstructions in both a clinic setting at his Northwestern Memorial Hospital offices, as well as in the operating room if necessary. The type of reconstruction that Dr. Kim performs will vary according to the defect location, size, and other anatomic and oncologic factors. Dr. Kim will work with dermatologists and surgical oncologists to ensure that there is a coordinated approach to the skin cancer removal and treatment to optimize the aesthetic outcome of the surgery.
Check out Dr. Kim’s article “Cosmetic outcomes following head and neck melanoma reconstruction: the patient’s perspective” here.
For sensitive locations of the face following skin cancer excision, Dr. Kim may use precise primary closure to approximate the tissues carefully and judiciously. For larger defects after Moh’s surgery or skin cancer removal, Dr. Kim may need to use local flaps which are tissues rotated and transposed into the defect.
Care has to be taken in the face to make sure that the tissue rearrangement does not overly alter the neighboring structures of the eye, nose, cheek and mouth. There is some artistry that has to be matched with the technical function of the procedure. Dr. Kim has published research on the issues related to cosmetic outcomes from these types of procedures.
On rare occasions, more complex procedures such as a forehead flap are required to reconstruct the defect. This is especially true for nasal defects. Dr. Kim performs this procedure in several stages with the end result being a natural reconstruction of the nose.
Additionally, there are times when Dr. Kim will take a skin graft from another part of the body and use it to cover a full-thickness defect from skin cancer excision and Moh’s surgery. This process takes a little longer to heal (4 weeks or more) and the skin color and texture will be slightly different from the native skin. However, in cases where a skin graft is used, there is often a paucity of local flap or primary closure options. These skin grafts will often be done in the operating room at Prentice Women’s Hospital or at Northwestern Memorial Hospital.
After surgery, Dr. Kim will continue to see you intermittently and employ a customized anti-scar regimen to help you optimize the appearance following Moh’s surgery or skin cancer excision.